BMC primary care最新文献

{"title":"Factors associated with functional health literacy and the quality of life of riverside residents served by the primary care network in the Brazilian amazon: a cross-sectional study.","authors":"Ana Kedma Correa Pinheiro, Carlos Eduardo Raymundo, Eliene do Socorro da Silva Santos, Marcio Yrochy Saldanha Dos Santos, Adriana de Oliveira Sarefino, Maria Helena do Nascimento Souza, Ingrid Bentes Lima, Raquel Gomes da Silva, Laura Maria Vidal Nogueira","doi":"10.1186/s12875-024-02684-y","DOIUrl":"10.1186/s12875-024-02684-y","url":null,"abstract":"<p><strong>Background: </strong>the riverside population lives in a vulnerable social situation, shaped by geographical, economic, social, and educational aspects that have repercussions on health literacy, the limitations of which can compromise Quality of Life. These specificities influence the actions of Primary Health Care, especially in the rural context. This study aimed to assess the factors associated with Functional Health Literacy and Quality of Life among riverside residents of the Brazilian Amazon who use Primary Health Care.</p><p><strong>Methods: </strong>a cross-sectional study with 312 users of a riverside Family Health Team, using the Health Literacy Test, classified as adequate, limited, and inadequate, and the Study Short Form 12 Health Survey questionnaire, analyzing the physical and mental components in isolation. A theoretical model was built to assess the associations between sociodemographic and environmental variables and the Functional Health Literacy and Quality of Life outcomes. The Functional Health Literacy outcome was considered as two dichotomous variables (inadequate versus adequate; limited versus adequate), while the Quality of Life outcomes were considered as counts, with a Poisson distribution. Thus, a structural equation model was used to adjust the proposed theoretical model.</p><p><strong>Results: </strong>there was a worsening in inadequate Functional Health Literacy, associated with females, aged over 40, elementary school education, living close to the health service, and using only a cell phone for communication. Factors that compromised physical Quality of Life: livelihood problems; inadequate literacy; age range 40-59; and having two children or more. And those that worsened mental Quality of Life: age over 40; having a family allowance; and being in control of their medication.</p><p><strong>Conclusions: </strong>sociodemographic, environmental, and economic factors and adherence to medication by river communities have been shown to be associated with Health Literacy and Quality of Life. Knowing these implications is fundamental for health provision. These findings can support the formulation of strategies in health services to improve Health Literacy and Quality of Life.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"25 1","pages":"428"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11658385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acceptability of a resource-oriented approach (DIALOG+) among patients with chronic physical illnesses in primary health care-Uganda, a qualitative study.","authors":"Racheal Alinaitwe, N Nakasujja, H Birabwa-Oketcho, Akena Dickens, Francois van Loggerenberg, W W Muhwezi, Seggane Musisi, V Bird, S Priebe, N Sewankambo","doi":"10.1186/s12875-024-02681-1","DOIUrl":"10.1186/s12875-024-02681-1","url":null,"abstract":"<p><strong>Background: </strong>Chronic physical illnesses are often associated with significant psychological distress and chronic mental illnesses are often co-morbid with physical illnesses. Efforts to integrate mental health into primary health care in Uganda are underway. However, there are enormous logistical challenges. Effective resource-oriented and evidence-based interventions such as DIALOG + have the potential to improve treatment outcomes for patients with chronic conditions. We aimed to assess the acceptability of DIALOG + among patients with chronic physical illnesses in Uganda.</p><p><strong>Methods: </strong>This was a qualitative aspect of a mixed methods exploratory non-controlled study conducted in chronic physical illness out-patient clinics at two hospitals in Uganda. We conducted fifteen in-depth interviews with patients, ten key informant interviews with clinicians, and four focus group discussions with patients. Thematic data analysis was done through an iterative process.</p><p><strong>Results: </strong>The results support the acceptability of the intervention as evidenced by willingness to participate, better relationships between patients and clinicians, and improved control of both physical illnesses and psychological distress. Participants also talked about ways in which the implementation of DIALOG + could be improved.</p><p><strong>Conclusion: </strong>DIALOG + is acceptable among patients with chronic physical illness in primary health care settings in Uganda.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"25 1","pages":"429"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11656955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and facilitators for preventing mother-to-child transmission of Trypanosoma cruzi and hepatitis B in the Gran Chaco region: a qualitative analysis using the consolidated framework for implementation research (CFIR).","authors":"Yoshiko Takahashi, Susana Avila, Silvia Correa, Karina Cardone, Mariana Fernández, Favio Crudo, Miho Sato, Hirotsugu Aiga, Kenji Hirayama, Freddy Perez, Maria Victoria Periago","doi":"10.1186/s12875-024-02683-z","DOIUrl":"10.1186/s12875-024-02683-z","url":null,"abstract":"<p><strong>Background: </strong>Mother-to-child transmission (MTCT) of Trypanosoma cruzi and hepatitis B virus (HBV) increases morbidity and disability in Latin America and the Caribbean. The tailormade comprehensive antenatal care based on the Framework for the elimination of MTCT of HIV, syphilis, hepatitis B virus (HBV), and Chagas disease (EMTCT Plus) has been implemented in the region since 2018 through a private-public partnership. This study aimed to estimate the effectiveness of the intervention in preparing MTCT of T. cruzi and hepatitis B. The study further attempted to identify the barriers to and facilitators for preventing MTCT of T. cruzi and HBV in the Gran Chaco region of Argentina and Paraguay.</p><p><strong>Methods: </strong>Data on T. cruzi and HBV screening and treatment among pregnant women and infants were collected from antenatal care (ANC) registries between June 2018 and December 2022. A cascade-of-care analysis was applied to assess the intervention's effectiveness and identify bottlenecks. Additionally, key informant interviews were conducted for both implementors and service recipients to identify barriers to and facilitators for accessing screening and treatment using the Consolidated Framework for Implementation Research.</p><p><strong>Results: </strong>A total of 1,658 pregnant women were recruited, achieving 100% antenatal care coverage and screening for T. cruzi and HBV. The prevalence of T. cruzi among pregnant women was 3.3% (95%CI: 2.4-4.1%), while in newborns it was 14.0% (95% CI: 6.0-25.0). Treatment coverage for newborns infected with T. cruzi was 100%, whereas post-delivery treatment coverage among mothers was 67.3%. This achievement was likely attributed to strong community engagement, contributing to 100% ANC coverage. However, barriers such as a fragile local health system, long-term follow-up requirements, high mobile populations, cultural beliefs, and social trauma were identified in target areas.</p><p><strong>Conclusion: </strong>Implementing the EMTCT Plus Framework improved access to quality ANC in the study area. Nevertheless, continuous follow-up for T. cruzi screening and treatment for post-delivery remains challenging. To improve access to healthcare and ensure the sustainability of the intervention, an intercultural approach that empowers the community, alongside efforts to strengthen the local health system, is recommended.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"25 1","pages":"430"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11660772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Space, time, and presence in video consultations: an interview study in Danish general practice.","authors":"Frida Greek Kofod, Anne-Marie Søndergaard Christensen, Elisabeth Assing Hvidt, Anne Beiter Arreskov, Ann Dorrit Guassora","doi":"10.1186/s12875-024-02660-6","DOIUrl":"10.1186/s12875-024-02660-6","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this interview study was to explore patients' and general practitioners' (GPs') experiences of space, time, and presence in video consultation in general practice in Denmark.</p><p><strong>Methods: </strong>The study included six GPs and seven patients from the Copenhagen area, with different experience of video consultations. The data consisted of semi-structured interviews with all participants including recordings from their video consultations. The transcribed interviews were analyzed by Interpretative Phenomenological Analysis (IPA). The theoretical analysis was inspired by philosopher K.E. Løgstrup's writings about time, space, presence and sensation.</p><p><strong>Results: </strong>Both the patients and the GPs experienced a lack, or a different form, of presence in video consultations, comparing it to face-to-face consultations. Patients felt more secure in their own homes and the GPs found some of them to be more relaxed during the video consultation than in the face-to-face consultation taking place in the surgery. However, the consultation felt more superficial, with the GPs and patients experiencing an alteration in their sensory access to one another. The video consultation was also perceived as purpose-driven and action-oriented. Both patients and GPs felt that time was saved. According to K.E. Løgstrup, our experience is always composed of spatiality and temporality; the space is where we sense one another and experience duration, while time is the awareness of change and action. The theoretical analysis points to the experience of presence as spatial and, owing to the changed space in video consultations, the experience of presence and time is changed.</p><p><strong>Conclusion and implications: </strong>The balance between space and time is altered in the video consultation. GPs and patients lack certain sensory impressions, owing to the changed spatiality. The changed spatiality, sensation and experiences of presence lead the participants to eliminate the expendable elements to make the consultation more efficient. Video consultations allow some issues to be handled quickly, but the option for physical consultations still needs to be available, as we believe we now can argue that the physical consultation room has importance for the experience of presence and time.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"25 1","pages":"425"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11656864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"People living with chronic pain in Canada face difficult decisions and decisional conflict concerning their care: data from the national DECIDE-PAIN survey.","authors":"Florian Naye, France Légaré, Chloé Cachinho, Thomas Gérard, Karine Toupin-April, Maxime Sasseville, Jean-Sébastien Paquette, Annie LeBlanc, Isabelle Gaboury, Marie-Eve Poitras, Linda C Li, Alison M Hoens, Marie-Dominique Poirier, Yannick Tousignant-Laflamme, Simon Décary","doi":"10.1186/s12875-024-02667-z","DOIUrl":"10.1186/s12875-024-02667-z","url":null,"abstract":"<p><strong>Background: </strong>Shared decision-making is an imperative in chronic pain care. However, we know little about the decision-making process, especially in primary care where most chronic pain care is provided. We sought to understand decisional needs of people living with chronic pain in Canada.</p><p><strong>Methods: </strong>We conducted a population-based cross-sectional online survey of random samples of adults living in Canada with chronic noncancer pain and registered with the Leger Marketing panel. We followed the International Association for Study of Pain definition of chronic pain (i.e., persistent or recurrent pain lasting longer than three months). We used a stratified proportional random sampling based on the population and chronic pain prevalence of each province to achieve representativeness. Based on the Ottawa Decision Support Framework, we collected data on difficult decisions (i.e., decision with more than one option and no clear best option) related to their chronic pain condition, the level of decisional conflict associated with the most difficult decisions (i.e., Decisional Conflict Scale), the assumed and preferred role during the decision-making process (i.e., Control Preferences Scale), and respondents' characteristics. We used descriptive quantitative analyses of survey responses.</p><p><strong>Results: </strong>Of the 31,545 invited panellists, 2,666 met the eligibility criteria, and 1,649 respondents from the 10 Canadian provinces completed the survey. Respondents had diverse socio-demographic profiles. Mean age was 51.8 years (SD = 16.3). Half were men (51.4%), most lived in urban areas (87.8%), mean pain duration was 8.5 years (SD = 9.6), and respondents reported an average number of painful body regions of 2.3 (SD = 1.5). We observed that 96.7% of respondents faced at least one difficult decision across their care pathways. These difficult decisions were related to numerous issues from the medical consultation, diagnosis, treatment, and daily life. Almost half of respondents made their most difficult decision with a primary care physician. One third of respondents experienced a high level of clinically significant decisional conflict (Decisional Conflict Scale score ≥ 37.5). Two-thirds of respondents self-reported having a collaborative role during their decision while three-quarters wanted this role.</p><p><strong>Conclusions: </strong>People living with chronic pain in Canada have unmet decisional needs and need support to make optimal decisions to manage their chronic pain. Our findings will guide future development of interventions to implement shared decision-making, especially to support primary care where discussions about difficult decisions often occur.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"25 1","pages":"424"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11657379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing \"what matters most\" to reduce mental health stigma in primary healthcare settings: a qualitative study in Lebanon.","authors":"Racha Abi Hana, Eva Heim, Pim Cuijpers, Marit Sijbrandij, Rabih El Chammay, Brandon A Kohrt","doi":"10.1186/s12875-024-02680-2","DOIUrl":"10.1186/s12875-024-02680-2","url":null,"abstract":"<p><strong>Background: </strong>\"What matters most\" (WMM) is a theoretical framework based on medical anthropology and draws on cultural concepts of values and morals. It has been employed to identify cross-cultural aspects of mental health stigma. This approach assists practitioners, advocates, and researchers in assessing stigma-related factors that are relevant to the experiences of individuals in diverse cultural contexts. To implement effective anti-stigma programmes it is vital to identify and prioritize WMM for primary healthcare providers and people with lived experience of mental health conditions (PWLE). Our current objective was to explore WMM to primary healthcare providers, PWLE, primary care managers, and policymakers in Lebanon to inform mental health stigma reduction initiatives.</p><p><strong>Methods: </strong>We conducted a total of 45 qualitative interviews with primary healthcare providers, PWLE, primary care managers, and policymakers. The WMM framework was applied to analyse data from primary healthcare centres in Lebanon to identify themes related to stigma against PWLE. The analysis identified common themes related to WMM. The analysis aimed to identify (a) WMM values for participants, (b) factors that threaten these WMM values and their relationship to stigma, and (c) potential interventions that could leverage WMM principles to reduce stigma.</p><p><strong>Results: </strong>WMM for primary healthcare providers encompassed competency, time management, willingness, and self-care. WMM for PWLE focused on equality, support, compassion, and confidentiality. Policymakers emphasised resource sustainability as a top priority. Myths about mental health illnesses perpetuated threats to WMM, and organisational barriers also threatened WMM for primary healthcare providers and PWLE, thus creating major roadblocks to achieving stigma reduction.</p><p><strong>Conclusion: </strong>This study identified key domains to understand the factors for WMM in reducing mental health stigma in Lebanon and explored factors that shape the values and priorities of both PWLE and primary healthcare providers. The study suggests assessing the effectiveness of anti-stigma interventions that actively engage PWLE in their design and implementation, while exploring the broader applicability of the WMM framework across different cultural and healthcare settings.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"25 1","pages":"427"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11657562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"General practitioners experience multi-level barriers to implementing recommended care for hip and knee osteoarthritis: a qualitative study.","authors":"Alison J Gibbs, Christian J Barton, Nicholas F Taylor, Joanne L Kemp, Jason A Wallis, Jo-Anne Manski-Nankervis, Allison M Ezzat","doi":"10.1186/s12875-024-02658-0","DOIUrl":"10.1186/s12875-024-02658-0","url":null,"abstract":"<p><strong>Background: </strong>General practitioners (GPs) play a key role in managing osteoarthritis, including referring to appropriate management services. Physiotherapist-led osteoarthritis management programs and advanced practice triage services are effective, but GPs views on them are largely unknown. This study aimed to explore general practitioner perspectives on: (1) managing patients with hip and knee osteoarthritis, and (2) physiotherapy-led osteoarthritis care and referral pathways.</p><p><strong>Methods: </strong>Interview topic guides were developed based on the theoretical domains framework. Twenty-five semi-structured interviews with GPs were conducted. All data were coded independently by at least two researchers and analysed inductively using thematic analysis, with barrier themes mapped to the socioecological model.</p><p><strong>Results: </strong>Two interrelated themes were identified: (i) GPs had good general knowledge of recommended osteoarthritis care, but (ii) they faced multi-level challenges facilitating or directly providing evidence-based care. Nearly all GPs identified exercise as first-line care and surgery as a last resort. Most were aware imaging was not required to diagnose osteoarthritis, yet reported often referring for imaging. Many GPs expressed challenges facilitating patient engagement in physiotherapy due to patient, environmental/social and system level barriers. Key barriers included: perceived patient expectations and lack of motivation to attend physiotherapy, a lack of knowledge of available physiotherapy services, a lack of affordable physiotherapy services, and lengthy waiting times for public orthopaedic appointments. Having private health insurance was perceived as an enabler.</p><p><strong>Conclusions: </strong>Despite having good knowledge of guideline-recommended care, GPs in our study experienced multi-level barriers to implementing this care in practice. Public health information and strategies to address patient's beliefs and lack of motivation to exercise may help reduce barriers to engaging in appropriate care. Urgent health system funding reforms are needed to allow GPs to appropriately manage patients with hip and knee osteoarthritis.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"25 1","pages":"423"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11657540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Signing contracts for family doctors, functional limitations and home care willingness among older adults: a cross-sectional study.","authors":"Shujun Chai, Dan Zhao, Tingting Gao, Jingjie Sun, Peilong Li, Xueqing Wang, Xuehong Wang, Jingjing Luo, Jiayan Li, Chengchao Zhou","doi":"10.1186/s12875-024-02661-5","DOIUrl":"10.1186/s12875-024-02661-5","url":null,"abstract":"<p><strong>Background: </strong>Traditional Chinese culture advocates home care be provided by family members. Home care can improve mental health and enjoy a familiar environment for older people. This study aimed to investigate the relationship between signing contracts for family doctors and home care willingness, as well as the interaction effect of functional limitations in this relationship.</p><p><strong>Methods: </strong>This study was based on the sixth National Health Service Survey of Shandong province, China in 2018. A total of 8,055 older adults aged ≥ 60 years were included in the study. The logistic regression models were employed to examine the role of functional limitations in the relationship between signing contracts for family doctors and home care willingness.</p><p><strong>Results: </strong>There were 6,891 (85.55%) participants had home care willingness in Shandong province, China. Compared to respondents who did not have family doctors, older adults with family doctors were more likely to report higher levels of home care willingness after adjusted for covariates (OR = 1.45, 95% CI: 1.27, 1.66). The interaction effect between signing contracts for family doctors and functional limitation on choosing home care for older adults was statistically significant (OR = 0.68, 95% CI: 0.47, 0.97).</p><p><strong>Conclusions: </strong>The association between signing contracts for family doctors and home care willingness varies by functional limitations. Therefore, there is a need to improve social security system and family doctor service policy to suit the care needs of older people, especially those without functional limitations. Social care institutions should also provide comfortable care to disabled older adults as an effective complement.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"25 1","pages":"422"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11656915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating academic detailing as an antibiotic stewardship intervention in primary healthcare settings in Croatia.","authors":"Darija Kuruc Poje, Domagoj Kifer, Maja Kuharić, Katarina Gvozdanović, Željka Draušnik, Ana Posavec Andrić, Vesna Mađarić, Vlatka Janeš Poje, Marina Payerl-Pal, Arjana Tambić Andrašević, Juraj Mark Poje, Vesna Bačić Vrca, Srećko Marušić","doi":"10.1186/s12875-024-02679-9","DOIUrl":"10.1186/s12875-024-02679-9","url":null,"abstract":"<p><strong>Background: </strong>Acute respiratory tract infections are common in primary healthcare care settings and frequently result in antibiotic prescriptions, despite being primarily viral. There is scarcity of research examining impact of academic detailing (AD) intervention on prescribing practices for these infections in resource-constrained healthcare settings like southeastern Europe. Therefore aim of this study was to evaluate impact of AD intervention as an antimicrobial stewardship measure on antibiotic prescribing for acute respiratory tract infections in primary setting in Croatia which is located in southeastern Europe. Secondary goal included examining incidence of Clostridioides difficile infections (CDI) which are often associated with antibiotic consumption.</p><p><strong>Methods: </strong>AD intervention was implemented from 1st to 30th April 2020 and led by hospital healthcare professionals (infectious disease physician, clinical microbiology physician and clinical pharmacist). They focused on enhancing prescribing behaviors of primary care physicians (PCPs) by presenting local data, supplemented by examples from everyday practice, research and guidelines highlighting negative consequences of imprudent antibiotic use. This feasibility quasi-experimental study had two control groups in two counties. Impact of AD intervention was assessed by analyzing antibiotic prescription patterns using log-linear model, adjusting for seasonality. Study focused on prescribed daily defined doses (DDD) per day among PCPs pre-intervention (from 01st January 2018 to 31st March 2020) and post-intervention (from 1st May 2020 to 31st December 2022).</p><p><strong>Results: </strong>Data was collected from sixteen out of fifty-seven eligible PCPs with mean 29 years (SD 11.38) in practice. Statistically significant difference results (p < 0.05) favored AD intervention, leading to 30% decline in antibiotic prescribing in adjusted DDD per day for acute pharyngitis (21.14 post-intervention/30.27 pre-intervention), 33% decline for acute tonsilitis (24.91/37.38), 23% decline for acute upper respiratory infection (21.26/27.62) and 36% decline for acute bronchitis (8.13/12.77). Although there was 14% decline for acute sinusitis post-intervention, it did not reach statistical significance (30.96/35.93) (p = 0.617). Incidence of CDI cases decreased in investigated county while in control county stayed the same. Inter-county difference in these changes was not statistically significant (ratio = 0.749, 95% CI, 0.460-1.220; p = 0.246).</p><p><strong>Conclusions: </strong>This feasibility study showed reductions in antibiotic prescribing for acute respiratory tract infections, emphasizing the efficacy of targeted, educator-led programs. Tailored healthcare strategies are vital, especially in Croatia and southeastern Europe, for promoting sustainable practices and addressing antimicrobial resistance challenges.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"25 1","pages":"426"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11657582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-oriented unsupervised learning to uncover the patterns of multimorbidity associated with stroke using primary care electronic health records.","authors":"Marc Delord, Xiaohui Sun, Annastazia Learoyd, Vasa Curcin, Charles Wolfe, Mark Ashworth, Abdel Douiri","doi":"10.1186/s12875-024-02636-6","DOIUrl":"10.1186/s12875-024-02636-6","url":null,"abstract":"<p><strong>Background: </strong>We aimed to identify and characterise the longitudinal patterns of multimorbidity associated with stroke.</p><p><strong>Methods: </strong>We used an unsupervised patient-oriented clustering approach to analyse primary care electronic health records (EHR) of 30 common long-term conditions (LTC) in patients with stroke aged over 18, registered in 41 general practices in south London between 2005 and 2021.</p><p><strong>Results: </strong>Of 849,968 registered patients, 9,847 (1.16%) had a record of stroke and 46.5% were female. The median age at record of stroke was 65.0 year (IQR: 51.5-77.0) and the median number of LTCs in addition to stroke was 3 (IQR: 2-5). We identified eight clusters of multimorbidity with contrasted socio-demographic characteristics (age, gender, and ethnicity) and risk factors. Beside a core of 3 clusters associated with conventional stroke risk-factors, minor clusters exhibited less common combinations of LTCs including mental health conditions, asthma, osteoarthritis and sickle cell anaemia. Importantly, complex profiles combining mental health conditions, infectious diseases and substance dependency emerged.</p><p><strong>Conclusion: </strong>This novel longitudinal and patient-oriented perspective on multimorbidity addresses existing gaps in mapping the patterns of stroke-associated multimorbidity not only in terms of LTCs, but also socio-demographic characteristics, and suggests potential for more efficient and patient-oriented healthcare models.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"25 1","pages":"419"},"PeriodicalIF":2.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11656854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}